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Evolocumab: Benefits, Dosage, and How This PCSK9 Inhibitor Works
Summary or Key Points
Evolocumab is a medication used to lower LDL cholesterol, particularly in individuals with hyperlipidemia, cardiovascular disease, or familial hypercholesterolemia. As a PCSK9 inhibitor, it helps the body remove “bad” cholesterol from the bloodstream. This medication is often prescribed when other cholesterol-lowering treatments, such as statins, are not sufficient. Always consult your healthcare provider before starting or adjusting your dose of Evolocumab.
Names of Medication
US Brand Name: Repatha (Evolocumab)
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this case, Evolocumab is the generic name, and Repatha is the brand name.
Pharmacologic Category
PCSK9 Inhibitors
Evolocumab belongs to a class of drugs known as PCSK9 inhibitors. These medications work by blocking a specific protein in the liver that regulates cholesterol levels, making them highly effective at reducing LDL cholesterol.
Dosing
Evolocumab is used to treat various conditions related to high cholesterol and cardiovascular disease. The dosage may vary depending on the specific condition being treated. Always consult your healthcare provider before adjusting your dose or starting treatment. You can also schedule a telemedicine appointment with one of our providers to discuss your individual needs.
Hyperlipidemia
For adults with hyperlipidemia (high cholesterol), the typical dosage of Evolocumab is 140 mg injected subcutaneously (under the skin) every two weeks or 420 mg once monthly.
Familial Hypercholesterolemia
In adults with familial hypercholesterolemia, a genetic condition that causes very high cholesterol, the recommended dose is 140 mg subcutaneously every two weeks or 420 mg once monthly.
Cardiovascular Disease (CVD)
For patients with cardiovascular disease, such as those who have experienced a heart attack or stroke, the usual dose of Evolocumab is 140 mg every two weeks or 420 mg once monthly.
Atherosclerosis and Coronary Artery Disease
To reduce the risk of complications from atherosclerosis or coronary artery disease, the typical dose is 140 mg every two weeks or 420 mg once monthly.
Stroke and Heart Attack Prevention
For patients at risk of stroke or heart attack, Evolocumab is typically prescribed at 140 mg every two weeks or 420 mg once monthly to help prevent these cardiovascular events.
Peripheral Artery Disease
For patients with peripheral artery disease, the recommended dose is 140 mg every two weeks or 420 mg once monthly.
Type 2 Diabetes and Metabolic Syndrome
While Evolocumab is not specifically indicated for treating type 2 diabetes or metabolic syndrome, it may be prescribed to help manage cholesterol levels in patients with these conditions. The dosing is typically 140 mg every two weeks or 420 mg once monthly.
Dosage Forms and Strengths
Evolocumab is available in the following dosage forms and strengths:
- Pre-filled syringe: 140 mg/mL
- Pre-filled autoinjector (SureClick): 140 mg/mL
- Single-use Pushtronex system (on-body infusor with prefilled cartridge): 420 mg/3.5 mL
Administration Instructions
Evolocumab is administered as a subcutaneous injection, meaning it is injected under the skin. After receiving proper training from a healthcare provider, it can be self-administered. The injection is typically given in the abdomen, thigh, or upper arm. Be sure to rotate injection sites to avoid irritation. If you are unsure how to administer the medication, contact your healthcare provider or schedule a telemedicine appointment for further guidance.
Contraindications
A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. Before starting Evolocumab, it’s important to know if you have any conditions that would make this medication unsafe for you.
Allergy to Evolocumab or its ingredients: If you have had an allergic reaction to Evolocumab or any of its components, you should not take this medication. Allergic reactions can include symptoms such as rash, itching, swelling, or difficulty breathing, which can be life-threatening.
Hypersensitivity reactions: Some patients may experience severe hypersensitivity reactions, such as angioedema (swelling under the skin) or anaphylaxis (a severe allergic reaction). If you have experienced these reactions before, Evolocumab is not recommended.
If you are unsure whether you have any of these conditions, please consult with one of our healthcare providers through telemedicine before starting Evolocumab.
Drug to Drug Interactions
Evolocumab generally has a low potential for drug interactions, but it’s always important to inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and supplements. Currently, there are no significant known drug interactions with Evolocumab. However, always check with your healthcare provider to ensure that it is safe to take Evolocumab alongside your current medications.
Evolocumab in Pregnancy
Is it safe to take Evolocumab when pregnant?
The safety of Evolocumab, a PCSK9 inhibitor, during pregnancy has not been fully established. While animal studies have not shown harm to the fetus, there is limited data on its use in pregnant women. Therefore, Evolocumab should only be considered during pregnancy if the potential benefits clearly outweigh the risks. If you are pregnant or planning to become pregnant, it is essential to consult your healthcare provider to determine the safest way to manage your cholesterol levels during pregnancy.
Evolocumab while Breastfeeding
Is it safe to take Evolocumab while breastfeeding?
It is currently unknown whether Evolocumab passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally recommended to either discontinue the medication or stop breastfeeding. If you are breastfeeding or planning to breastfeed, discuss the risks and benefits of continuing Evolocumab with your healthcare provider to make an informed decision about your treatment.
Estimated Cost of Evolocumab (Repatha)
The estimated cost of a 30-day supply of Evolocumab (Repatha) without insurance ranges from $500 to $600 when using a GoodRx coupon. Prices may vary depending on the pharmacy and location. To find the best price for this cholesterol-lowering medication, check with your pharmacy or use a coupon service like GoodRx.
Possible Alternatives to Evolocumab
Depending on your condition, alternative treatments or lifestyle changes may help manage cholesterol levels and reduce cardiovascular risk. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to explore these alternatives.
Hyperlipidemia
Alternatives include statins (e.g., atorvastatin, simvastatin), ezetimibe (Zetia), or lifestyle modifications such as adopting a heart-healthy diet, engaging in regular exercise, and maintaining a healthy weight. These options can effectively lower LDL cholesterol and improve overall heart health.
Familial Hypercholesterolemia
In addition to Evolocumab, other treatment options include statins, ezetimibe, or LDL apheresis (a procedure that removes LDL cholesterol from the blood). These treatments are often used in combination to manage this genetic condition.
Cardiovascular Disease
Lifestyle changes such as quitting smoking, reducing alcohol consumption, and managing stress can significantly lower the risk of cardiovascular events. Medications like aspirin, beta-blockers, and ACE inhibitors may also be prescribed to support heart health and reduce the risk of complications.
Atherosclerosis
Statins, antiplatelet agents (e.g., aspirin), and lifestyle changes such as following a low-fat diet and engaging in regular physical activity can help slow the progression of atherosclerosis, a condition where plaque builds up in the arteries.
Coronary Artery Disease
In addition to Evolocumab, treatments may include statins, beta-blockers, and lifestyle changes such as improving diet and increasing physical activity. These interventions aim to reduce the risk of heart attacks and other cardiovascular complications.
Stroke
Preventive measures include controlling high blood pressure, managing diabetes, and taking medications like aspirin or anticoagulants to reduce the risk of blood clots, which can lead to strokes.
Heart Attack
After a heart attack, medications such as beta-blockers, ACE inhibitors, and statins are commonly prescribed. Lifestyle changes, including quitting smoking and maintaining a healthy weight, are also crucial for recovery and preventing future heart attacks.
Peripheral Artery Disease
Treatment options include statins, antiplatelet medications, and lifestyle changes such as walking programs and quitting smoking. These interventions help improve blood flow and reduce symptoms associated with the condition.
Type 2 Diabetes
Managing blood sugar levels through medications like metformin or insulin, along with lifestyle changes such as a balanced diet and regular exercise, can help reduce cardiovascular risks associated with diabetes.
Metabolic Syndrome
Lifestyle changes, including weight loss, increased physical activity, and a healthy diet, are key to managing metabolic syndrome. Medications like statins or blood pressure drugs may also be prescribed to reduce the risk of cardiovascular disease.
Recent Updates on Evolocumab Research
Recent studies continue to support the effectiveness of Evolocumab in reducing LDL cholesterol levels and lowering the risk of cardiovascular events, such as heart attacks and strokes. A 2022 study published in the Journal of the American College of Cardiology found that patients who took Evolocumab alongside statins experienced a significant reduction in cardiovascular events compared to those who took statins alone.
Ongoing research is also exploring the long-term safety of Evolocumab, particularly in patients with high cardiovascular risk. Additionally, studies are investigating the potential benefits of Evolocumab in patients with other conditions, such as chronic kidney disease and diabetes, to determine if it can provide broader cardiovascular protection.
As new research emerges, it’s important to stay informed and discuss any updates with your healthcare provider. If you have any questions or concerns about Evolocumab, schedule a telemedicine appointment with one of our providers today.
